HEADQUARTERS

DEPARTMENT OF MILITARY SCIENCE AND TACTICS

PHILIPPINE COLLEGE OF CRIMINOLOGY ROTC UNIT
1304TH (MANILA) CDC, NCRRCDG, RESCOM, PA
Sales Street, Sta Cruz, Manila

ROTC REGISTRATION FORM

Student No: 23-0712 MS: 1 Date:___November 12,2023__

Name: BERMUDEZ FRANCINE IRIZ ESCOREL
(Last Name) (First Name) (Middle Name)

Course: Forensic Science Year & Section: 1A01 School: PCCR Religio_Catholic
Date of Birth: July 18,2005 Place of Birth: Manila Age: 18
Height (ft): 5’1 Weight (kg): 39 Complexion: White Blood Type: N/A_
Gender: Female Email Address: _23-0712.bermudez@my.pccr.edu.ph

Permanent Address:
No/St/Vill/Brgy: 2736 Victoria Street Brgy 179
Municipality: Metro Manila City
Province: Manila Region: NCR
Telephone/CellNumber:09460734012
Father: Francis Bryan C. Bermudez Occupation: Liason Officer
Mother: Imee E. Bermudez Occupation: Security Agent
Person to be notify in case of emergency
Name: Imee E. Bermudez Relationship: Mother
Address 2744 Rosalina St. Gagalangin Tondo Manila Tel No/CellNumber:_09063573492_
Military Science Completed:
MS SEMESTER SCHOOL YEAR GRADE REMARKS
_______________ ______________ _______________ _______ ________________
_______________ ______________ _______________ _______ ________________
_______________ ______________ _______________ _______ ________________
_______________ ______________ _______________ _______ ________________
Do you intend to take the Advance ROTC course? ( ) Yes ( / ) No

Why? Because of my health issue

This is to certify that the above data is true and correct:

______________________________
2x2 (Signature of Student)

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